A caller to our office suffered a really serious shoulder injury that was going to keep her out of work for three months or more following a surgery. She was in physical therapy and making great progress, but got very upset and nervous after receiving a call from an insurance adjuster telling her that she was at risk having her benefits cut off.
Long story short is that she and her husband had planned a wedding anniversary trip for a long time and it was coming up in a week. It was supposed to be a week of rest and relaxation in Mexico, but it would cause her to miss three physical therapy sessions. The adjuster said that if she went her benefits would be cut off for not being compliant with her medical care.
So, can they do that?
Like most cases, the answer is it depends. Getting hurt at work doesn’t mean you give up your life. If you hurt your shoulder you’ll probably have to drop out of your bowling league, but it doesn’t prevent you from going out to dinner with friends. You aren’t expected to be a shut in and sit on your couch all day until you are 100% better. Life goes on and you are allowed to live it.
So can she go on a vacation for a week? Absolutely. She’ll need to be careful with the luggage and if she gets caught water skiing or doing some other activity that would be bad for her arm, that could hurt her case. If she decided she wanted to leave for an unreasonable period of time (e.g. more than 10 days or so) then it could hurt her case. If she wants to go on another vacation right after this and miss more therapy it could hurt her case.
Otherwise this is not unusual or unexpected and we’d push back hard against any attempt to screw with her benefits. Imagine if it was her daughter’s destination wedding. Is she supposed to skip that? That’s ridiculous. What if it was her high school reunion? Or Thanksgiving or Christmas? Life goes on even when you are hurt at work and you are allowed to live it.
The bottom line is that missing three physical therapy sessions won’t derail her recovery and quite honestly, she can talk to her therapist and they can give her a program to do while on vacation that will be 90% as good as going to the center. And it won’t cost the insurance company any money!!!
This is as they say a nothing burger other than an over zealous insurance adjuster messing with her. The good news is that it’s an easy fix.
If you have any concerns about a case, contact us at any time for a free consultation.
